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Fulltext Use of structured portfolio in surgical training of postgraduate medical education

Hassan S

Education in Medicine Journal, 2011;3(2):32-43.
MyJurnal

Background: Reflection on the process of learning is an essential ingredient in transforming novice into expert learners. Learning to compile portfolio encourages reflective skills, which help students to work systemically in translating metacognition into self-regulatory control in order to adjust their action and monitor their learning objectives. Introducing to compile portfolio in the early years of postgraduate training is an effective tool to stimulate students’ reflective abilities. Reflective learners are better motivated than the conventional learners to take the responsibilities as researcher in future. Reflective skills achieve both learning in right direction and learning for whole life. However, use of formal methods of reflective portfolio to monitor the learning objectives is an uncommon practice in postgraduate training, primarily due to intensive time and labor required. Challenged with those constraints in Master’s of Surgery Program of Otolaryngology and Head-Neck Surgery in School of Medical Sciences at Universiti Sains Malaysia, a structured self-reflective portfolio was introduced to determine its feasibility and acceptance among supervisors and trainees. Portfolio was practiced as one of the tool for formative assessment and for making recommendations to certify independent thyroid surgery allowed to practice in future. Methodology: A self-reflective structured portfolio was introduced to monitor the learning objectives in trainees of 2007 cohort, using a model as "mentor-system for authentic and structured learning with self-reflective assessment" (MASSRA). Initially a semi-structured portfolio comprising of 12 items and guidelines to compile a portfolio was followed by a structured format in training of thyroid module in sub-specialty of Head and Neck Surgery. Mentoring was organized by putting one-mentor verses 9 students to provide general pastoral guidance to compile portfolio as two entries a year. Mentors held the counseling session with student twice a year after evaluating the portfolios to monitor their progress. Besides, candidates were also observed for their performance in thyroid surgery during a 4-years training program. Those identified with problems for their level of training were referred to "Joint Committee for Surgical Training" comprising of 3 supervisors from Head and Neck Surgery Sub-specialty and a chairman supposedly the head of the department. 7 randomly selected students were also interviewed for direct feedback to evaluate this model. Result: 28 trainees at different level of their training compiled a self-reflection structured portfolio minimum twice a year with instructional feedback from the mentor, which was used as a tract for their personal development plan (produced by each trainee) for training in thyroid surgery. Initial analysis of portfolio revealed interesting feedback from the trainees reflecting on their knowledge, surgical skills and attitude towards thyroid surgery seen in tables 2-4. Conclusion: Self-reflections about each structured items in portfolio-helped trainees to identify their problems, seek mentors guidance and work systemically to help adjust their actions by revising learning objectives. Though time and labor intensive, portfolio was rated as feasible and practical.
Fulltext Appraisal of weekly conducted clinical pathologic case conference (CPC)

Hassan S

Education in Medicine Journal, 2011;3(2):15-23.
MyJurnal

Background: The weekly held clinical pathologic case conference popularly known as CPC provides an effective and regular educational media of collaborative learning for inter-disciplinary exchange of knowledge among the faculty members of an institution. CPC has been routinely practiced for the last two decades in School of medical Sciences (SMS) at Universiti Sains Malaysia (USM). An hour session primarily involves a case presentation hiding the diagnosis followed by discussion on differential diagnosis and floor interaction on interesting clinical cases. It also gives an opportunity to new teaching staff in the institution to experience an in-house practice of presenting the clinical cases; witch can readily be reproduced as a case report for publication. An effort to follow the original format of CPC is comprehended as an essential outcome of this study to keep up the sanctity of CPC as a case method of learning medicine in future. Methodology: A questionnaire-based survey was recently conducted to evaluate the weekly held CPC in SMS. It was a cross sectional survey in which a questionnaire comprising of 23 items was administered to a targeted population of faculty members of School of Medical Sciences. The items in questionnaire were grouped into 5 clusters. All respondents were adequately briefed through a letter addressing the objectives and importance of survey and its appraisal aiming to revamp the CPC guided by the out-come of study. Questionnaires were administered to 240 academic staff, covering > 80% of the target population of 294 faculty members. 159 (66.2%) members of sample population completed the questionnaires. Total non-responses were 81 (33.7%) and item non-responses were 320 (8.7%) Result: All the items in questionnaire were found significant (p 0.016) except those two items related to, observing a difference in preparing for a case presentation verses a formal CPC presentation and its promotion (p 0.556 and 0.197 respectively). It was also established that the major respondents were unaware of the original format of CPC (p 0.003) in which a presenter select and prepares a case, which is discussed with participating faculty members for its differential diagnoses. 51.6% faculty members did not follow the formal CPC format (p 0.016) in their presentations. A lack of awareness about the format of CPC was shown by (61.0%) faculty members (p 0.003). Conclusion : It was concluded that emphasis to discuss the differential diagnosis by a competent discussant was lacking, as presenters did not follow the formal CPC format. It was critically observed that a number of presentations made in this weekly program deviate from the original format adapted by SMS in USM. However, the out-come appraisal of this survey was the pledge shown by the majority faculty members to adapt the guidelines as a reverence to the formal CPC format.
Fulltext Students perceptions about the immediate feedback assessment technique (If-At) in team based learning using pre-test versus post-test evaluation

Hassan, Shahid, Begum, Imtiaz, Hassan, Nabiha Gul

Education in Medicine Journal, 2018;10(1):25-34.
MyJurnal

Immediate feedback assessment technique (IF-AT) are self-scoring answer sheets, based on the
concepts of immediate feedback for choosing the correct answer in multiple choice questions (MCQs)
during group readiness assurance tests (GRATs) in team-based learning (TBL). IF-AT scratch card
system rewards a student with partial credit for proximate knowledge. This technique motivates
students to pursue learning with just-in-time feedback and gives them the opportunity for collaborative
learning and analytic reasoning among group members. A rubric for partial credit is decided pre-hand
depending upon the number of options used in MCQs. In this study, we assessed students’ perception
about immediate feedback assessment technique before and after the training. To determine students’
perception of the IF-AT scratch card system in instruction and assessment. Students perceptions
about the IF-AT system has been explored using a 25-item questionnaire administered to 60 students
assigned randomly to control and training groups using pre-test and post-test analysis. Paired-sample
t-test and independent-sample t-test statistics were employed and the data was analysed. Descriptive
statistics observed for mean (SD) was found greater in trained group = 58.48 (4.87) vs. control group
= 66.43 (5.81) with t-statistics significant at p = < 0.001. A significant difference in mean (SD) of
pre-test minus post-test scores (5.16) of control and trained group = 5.37 (4.85) and 10.53 (8.36)
respectively was also found with independent t-test analysis. It was found highly significant with
t = –2.92, p < 0.05 and the effect size of 78.1%, established by Cohen’s d criteria. The IF-AT system
provides an individualised and instantaneous instruction as feedback in an assessment, which is
marked with collaborative learning as in team-based learning. The IF-AT system promotes analytic
reasoning with problem solving skills through partial credit for proximate knowledge. Students’
perceive the concept of immediate feedback and partial credit for proximate knowledge as the most
important features of the IF-AT scratch card system.
Fulltext About clinicopathological conference and its' practice in the School of Medical Sciences, USM

Hassan S

Malays J Med Sci, 2006 Jul;13(2):7-10.
PMID: 22589598

The clinicopathological conference, popularly known as CPC primarily relies on case method of teaching medicine. It is a teaching tool that illustrates the logical, measured consideration of a differential diagnosis used to evaluate patients. The process involves case presentation, diagnostic data, discussion of differential diagnosis, logically narrowing the list to few selected probable diagnoses and eventually reaching a final diagnosis and its brief discussion. The idea was first practiced in Boston, back in 1900 by a Harvard internist, Dr. Richard C. Cabot who practiced this as an informal discussion session in his private office. Dr. Cabot incepted this from a resident, who in turn had received the idea from a roommate, primarily a law student.
Fulltext How to develop a core curriculum in clinical skills for undergraduate medical teaching in the school of medical sciences at Uiversiti Sains Malaysia?

Hassan S

Malays J Med Sci, 2007 Jul;14(2):4-10.
PMID: 22993486 MyJurnal

Clinical skills program as a laboratory method is a valuable adjunct to other forms of undergraduate medical training. This article describes the process of developing a core curriculum in clinical skills based on the Dundee model for a clinical skills centre. The School of Medical Sciences, in Universiti Sains Malaysia (USM) has been provided with a well equipped skills centre. However, the PBL curriculum in the undergraduate medical program in the school needs to be integrated with a clinical skills lab program. This is to counter the general feeling that the contribution of PBL is insignificant in terms of building clinical competency in an integrated system such as that used in USM compared to the traditional curriculi of other medical teaching institutions in Malaysia. Integrating clinical skills laboratory training with the PBL curriculum will provide evidence of PBL as an effective and innovative method for teaching and learning in Malaysia.
Fulltext Transnasal endoscopic repair for bilateral choanal atresia

Abdullah B, Hassan S, Salim R

Malays J Med Sci, 2006 Jul;13(2):61-3.
PMID: 22589606

Choana atresia is a congenital abnormality of the posterior nasal apertures affecting the newborn. The aetiology is considered to be a persistence of the embroyological bucconasal membrane which separates the nasal cavity from the stomatodeum until it breaks down at seventh week, allowing communication through the primitive posterior nares. Bilateral choanal atresia almost always present as a respiratory emergency because newborn babies are obligate nasal breathers. The definitive surgical treatment is repair under general anaesthesia. We report our experience in doing a new technique of transnasal endoscopic repair.
Fulltext Clinical and audiological profiles in children with chronic otitis media with effusion requiring surgical intervention

Abdullah B, Hassan S, Sidek D

Malays J Med Sci, 2007 Jul;14(2):22-7.
PMID: 22993488 MyJurnal

To determine the characteristic presenting symptoms, otoscopic findings, audiological profiles and the intraoperative findings of children with chronic otitis media with effusion who required surgical intervention. A prospective cross sectional study was undertaken in the otorhinolaryngology clinic of USM Hospital (HUSM) involving 25 cases (50 ears) of children with chronic otitis media with effusion requiring surgical intervention from June 1999 to September 2001. Their ages ranged from 3 to 12 years old. The gender distribution included males at 72 % and females at 28 %. The presenting symptoms noted were hearing impairment (52%), otalgia (18%), ear block (16%) and tinnitus (14%). The otoscopic findings were fluid in the middle ear (40%), dullness (32%) and retraction of the tympanic membrane (28%). On audiometry, 24 ears had moderate deafness (48%), 16 ears had mild deafness (32%) while 4 ears had severe deafness (8%). With tympanometry, 42 ears out of the total 50 had a flat type B curve (84%) while 6 ears had type As curve (12%). During myringotomy, middle ear secretion was seen in 38 ears (76%) out of the 50 ears; 22 ears had mucoid secretion while 16 ears had serous secretion. Clinically, the commonest presenting symptom was hearing impairment (52%) while the most common otoscopic finding was fluid in the middle ear (40%). Audiologically, most patients had moderate conductive hearing loss (48%) and a type B curve (84%) on tympanometry. On myringotomy middle ear fluid was found in 76 % of the ears.
Study site: otorhinolaryngology clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
Fulltext The routine histopathological examination of tonsillectomy specimens at Hospital Universiti Sains Malaysia - retrospective study and its implication

Mohamad I, Hassan S, Salim R

Malays J Med Sci, 2007 Jul;14(2):19-21.
PMID: 22993487 MyJurnal

Tonsillectomy is performed for several indications, the two commonest in practice are infective ( chronic tonsillitis ) and obstructive symptoms such as sleep apnea. The objective of this study is to determine the necessity of routinely performed histopathological examination of specimens post-tonsillectomy. In this paper, a retrospective evaluation of 480 specimens from 241 patient who has undergone tonsillectomies in Hospital Universiti Sains Malaysia between January 2004 and October 2005 was done. It was found that 462 ( 96.25 % ) were reactive lymphoid hyperplasia and 18 ( 3.75 % ) were follicular hyperplasia. None of them were found malignant. The result of this study indicate that routine histopathological examination of tonsillectomy specimens are unnecessary and results only in added cost and a loss of man hours.
Fulltext The routine histopathological examination of tonsillectomy specimens at Hospital Universiti Sains Malaysia - a retrospective study and its implication

Mohamad I, Hassan S, Salim R

Malays J Med Sci, 2007 Jan;14(1):53-5.
PMID: 22593652

Tonsillectomy is performed for several indications, the two commonest in practice are infective (chronic tonsillitis) and obstructive symptoms such as sleep apnea. The objective of this study is to determine the necessity of routinely performed histopathological examination of fonsillectomy specimens. In this paper, a retrospective evaluation of 480 specimens from 241 patient who had undergone tonsillectomies in Hospital Universiti Sains Malaysia between January 2004 and October 2005 was done. It was found that 462 (96.25 %) were reactive lymphoid hyperplasia and 18 (3.75 %) were follicular hyperplasia. None of them were found to be malignant. The result of this study indicates that routine histopathological examination of tonsillectomy specimens are unnecessary and results only in added cost and a loss of man hours.
Fulltext Challenges in the management of nasopharyngeal carcinoma: a review

Abdullah B, Alias A, Hassan S

Malays J Med Sci, 2009 Oct;16(4):50-4.
PMID: 22135512 MyJurnal

Nasopharyngeal carcinoma (NPC) is a non-lymphomatous, squamous cell carcinoma that occurs in the epithelial lining of the nasopharynx, an area that shows varying degrees of differentiation. Although relatively rare worldwide, NPC has substantial incidence and mortality in populations in Southeast Asia and in people with Southern Chinese ancestry. In Malaysia, NPC is a leading cancer type. In the clinic, NPC presents on a very wide spectrum. Therefore, a high degree of suspicion on the part of the clinician and an increased awareness by the patient is essential for the recognition of an early lesion. Early detection of the cancer is important as it affects the patient's prognosis and the mode of treatment. Managing patients with NPC is very challenging as patients usually present late when the cancer is already in an advanced stage. Here, we review the challenges in the management of NPC.
Fulltext Combined use of maxillomandibular swing approach and neurosurgical ultrasonic aspirator in the management of extensive clival chordoma: a case report

Hassan S, Abdullah JM, Wan Din SJ, Idris Z

J Med Case Rep, 2008;2:49.
PMID: 18279530 DOI: 10.1186/1752-1947-2-49

Chordoma is a rare malignant tumour with an incidence of metastasis of less than 10 percent. Usually arising from clivus its posterior extension may involve the brainstem before presenting as nasal mass and obstruction. Surgery is the main mode of treatment with adjuvant radiotherapy. However surgery is rarely possible for a large intracranial lesion.
Epstein-Barr virus DNA detection in the diagnosis of nasopharyngeal carcinoma

Yap YY, Hassan S, Chan M, Choo PK, Ravichandran M

Otolaryngol Head Neck Surg, 2007 Jun;136(6):986-91.
PMID: 17547993

OBJECTIVES: This study examines the presence of Epstein-Barr virus (EBV) in nasopharyngeal carcinoma (NPC) by using polymerase chain reaction (PCR).
STUDY DESIGN: Eighty-six postnasal biopsy samples and 71 fine-needle aspirate samples of neck masses were obtained from patients who were clinically suspect for NPC. Genomic DNA was extracted from the samples, and EBNA1, EBNA2, and LMP genes of EBV were detected by PCR. PCR results were compared with NPC histopathology findings.
RESULTS: The sensitivity of PCR to detect EBNA1 (97.14%), EBNA2 (88.57%), and LMP (91.43%) genes of EBV in nasopharyngeal biopsy samples were higher than those in fine-needle aspirate samples.
CONCLUSION: Detection of EBV by PCR in tissue obtained from nasopharyngeal biopsy and fine-needle aspirate samples of neck masses is a relatively inexpensive, reliable, and accurate method of diagnosing NPC. Detection of EBV genes is on par with histopathological examination (HPE) and superior to fine-needle aspirate cytology.
SIGNIFICANCE: PCR is an ideal tool for suggesting NPC and guiding the diagnostic workup in occult primary tumors, facilitating earlier diagnosis and reducing morbidity and mortality.
Fulltext Appraisal of clinical profile and management of juvenile nasopharyngeal angiofibroma in malaysia

Hassan S, Abdullah J, Abdullah B, Jihan Wd S, Jaafar H, Abdullah S

Malays J Med Sci, 2007 Jan;14(1):18-22.
PMID: 22593647 MyJurnal

Juvenile nasopharyngeal angiofibroma (JNA) is a benign but locally invasive tumour. Patients are usually in their adolescent age and present with epistaxis and nasal blockage. Diagnosis is based on clinical evaluation and the C.T. scan findings. Pre-operative superselective embolisation (SSE) and surgical excision is the treatment of choice. The out patient clinic of ORL-HNS hospital of University Science Malaysia received 25 referrals, all male, majority between 9-13 years of age and few adolescents. Clinically the patients were consistent with symptoms of recurrent epistaxis and nasal blockage. They reported from October 1998 to October 2001 from with in the state of Kelantan and the nearby states of Pahang, Kedah and Terenganu. Diagnosis was mostly made on typical radiological findings and the tumours were classified accordingly into four stages. SSE and surgical excision was carried out in all cases. Regular follow-up helped us to identify early recurrences which were treated with salvage surgery or radiotherapy in one case with extensive intracranial extension. A retrospective review of presenting features, diagnostic difficulties, surgical approaches and its outcome is presented. Maxillary swing procedure performed in three cases as a new surgical option in the management of JNA is also discussed.
Study site: ENT clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia

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